Designed for ease of use: how Philips Azurion is transforming the interventional lab

Since February 2017, the VU University Medical Center in Amsterdam has benefited from a hybrid OR that is equipped with Philips’ state-of-the-art Azurion angiography system. The operating room is now in full use, with the new platform helping clinicians perform procedures intuitively and easily, changing the way that care is given to patients. Interventional radiologist Martijn Meijerink and vascular surgeon Arjan Hoksbergen are both unanimous: “This system saves us a huge amount of time thanks to its outstanding image quality and navigation software.”

High standards of safety

As an interventional radiologist, Dr Meijerink focuses primarily on oncology care. The shift from invasive to minimally invasive treatment in this area has delivered major benefits including less trauma for the patient. However, as Dr Meijerink explained: “The main risk of complications is still from an infection. A sterile OR environment similar to the one provided with Azurion helps to decrease this risk, as there is a reduced need for team members to leave the sterile area and walk to the control room during procedures.”

Better navigation

The angiography system Dr Meijerink and Dr Hoksbergen had been using previously – the Philips Allura Xper FD20 – was already very advanced. However, as explained by Dr Meijerink: “It took longer. It takes time to search through seven branches of an artery to find the one feeder artery that leads to the tumor. With Azurion, this procedure has been sped up considerably thanks to the 3D rotational angiography facilities, cone beam CT, and the interventional tools, especially EmboGuide. With EmboGuide you indicate the target and the system then calculates from the tip of your catheter exactly which blood vessels lead to it. So you know precisely which blood vessels to use for the embolization. You can work faster and more accurately, and more efficiently too, because you’re targeting the whole tumor.”

Integration of images

Dr Hoksbergen: “The real benefit, in my opinion, is that you can merge images. It’s possible to lay a 3D reconstructed CT scan on top of the live image. This shows you exactly where you need to get to and you no longer have to walk to the control room to view a CT scan. Even during our very first procedure we noticed that we were able to reach small side branches much faster from the aorta and from prosthetics, at a low radiation exposure. And that wasn’t just because in that particular case the

patient’s anatomy happened to be easier. We seriously believe this was due to the high quality of the new system and the integration of all of the images.”

Dr Hoksbergen also believes there is now even less risk of positioning errors: “Thanks to the clear, detailed visualizations we’re able to position stents more efficiently. That is essential in these kinds of complex procedures. The imaging has been taken to a whole new level.”

Management in radiation

Dr Meijerink explained: “The Azurion system really helps to manage the amount of radiation required. Using just one 3D rotational angiogram we can devise any position we want without having to use more radiation.” Dr Hoksbergen agrees. ‘We don’t just want images of the aorta in which we are going to position the stent, we also want images of the blood vessels we’ll use for access and the side branches. Zero dose positioning means you can already see the effect of moving the table or changing the field-of-view on your region of interest to prepare your next run without using fluoroscopy. That’s better for the patient and for everyone else in the operating room.”

The system really helps to manage radiation. Using just one 3D rotational angiogram we can devise any position we want without having to use more radiation.”

dr. Meijerink

Interventional Radiologist, VU University Medical Center Amsterdam

Efficient for the operators

Azurion is equipped with a tablet-style touchscreen on the table, which means the operators can carry out all of the imaging processes, control the radiation dose and perform the various procedures. Dr Hoksbergen: “That means we rely less on people around us to look through images for us. This speeds things up and reduces unnecessary communication.”

Intuitive

Both doctors said they quickly found their way around the system. Dr Meijerink: “The system is very intuitive. We started with relatively simple procedures but, I have to say, we got used to working with it very quickly.” Dr Hoksbergen: “All of the specialists had a one-off application training session. After that, Philips was on hand in the first few weeks to provide guidance during the operations. It was a case of learning by doing, it’s a really good system.”

A major step forward

Dr Meijerink: “Any step forward in healthcare is usually a very small step, but this represents a huge step forward because it enables us to work together with vascular surgeons and other surgeons in one and the same room. As a result, we can now carry out a variety of complex interventions that, to our knowledge, didn’t exist with previous systems. This operating room offers multiple features in terms of diagnostic radiology, such as CT quality for needle-directed and catheter-directed interventions. The possibilities are endless.”

Dr Hoksbergen: “In the past we went from a normal C arc in the OR to the angio room. That was an enormous step forward. If you ask me, this step to the hybrid operating room is comparable with that. This is more than just an upgrade to 2.0, it’s a completely new way of working.”

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